1881815736 NPI number — JOHNNY GUEST LICENSED AID DEALER

Table of content: JOHNNY GUEST LICENSED AID DEALER (NPI 1881815736)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881815736 NPI number — JOHNNY GUEST LICENSED AID DEALER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUEST
Provider First Name:
JOHNNY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LICENSED AID DEALER
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881815736
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/15/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4226 BRISTOL PARK
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLOWERY BRANCH
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30542-3697
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-580-1982
Provider Business Mailing Address Fax Number:
850-372-4226

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2944 PENN AVE STE E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARIANNA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32448-2741
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-372-4548
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 237700000X , with the licence number:  HADE034820 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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